Provider Demographics
NPI:1487841490
Name:PIVOVARNIK, KERRY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:A
Last Name:PIVOVARNIK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1288
Mailing Address - Country:US
Mailing Address - Phone:877-888-2939
Mailing Address - Fax:
Practice Address - Street 1:3705 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1288
Practice Address - Country:US
Practice Address - Phone:877-888-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03113900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist